For some women, PMS symptoms can be mild and easy to handle—for others, they can be debilitating. But you don’t have to let it hold you back from everyday life. Here’s how to control your symptoms, straight from a doctor.
Cramping, bloating, mood swings—all common symptoms of premenstrual syndrome, a condition that about 90 percent of women experience, according to the Office of Women’s Health. PMS can stir up a wide range of issues, from the physical to the mental and the mild to the extremely severe. To start getting PMS relief and stop your PMS symptoms from controlling your day or your month, we talked to Jaclyn Tolentino, DO, lead physician at Parsley Health in Los Angeles. She shares what you need to know about PMS symptoms, plus what you can do to manage the mind and body side effects.
Why do some people have more severe PMS symptoms?
There’s no real concrete answer—symptoms can range so widely in severity and even in particular symptoms from person to person, that it’s difficult to nail down an exact reason for it, Tolentino says. One woman might not experience any PMS symptoms while another has to stay home to manage pain or anxiety. However, a few factors may potentially increase the chances of experiencing bad PMS. For example, those who have been pregnant, women in their 40s, those under intense stress or who have a history of depression, might all have more intense side effects, says Tolentino. It could also be hereditary. “If your mother experiences symptoms, you may be more likely to experience those symptoms as well,” Tolentino explains.
There are also a few theories on the mechanisms behind PMS symptoms. For instance, someone who experiences more intense PMS symptoms might be more sensitive to fluctuating sex hormones, like estrogen and progesterone, research in the journal Lancet has found. PMS might also be tied to low levels of serotonin, the brain hormone associated with happiness and mood stability.
For those women who experience pain or cramping before their periods, it could result from an inflammatory response in the uterus. The cells in the lining of the uterus secrete chemicals known as prostaglandins, Tolentino explains. These hormone-like substances, which trigger the uterus to contract to expel its lining, are involved in pain and inflammation. Typically, the more prostaglandins, the more severe your pain or cramps.
When should I talk to a doctor about PMS symptoms?
If your period lasts longer than 8-10 days or you’re experiencing severe or debilitating symptoms that are keeping you from work or from enjoying an active social life, it’s probably time to talk to (and work with) your doctor to see what you can do to help alleviate some PMS symptoms, Tolentino suggests. About 5 percent of women have premenstrual dysphoric disorder or PMDD, according to the Office of Women’s Health. A more severe form of PMS, PMDD can bring issues like panic attacks, depression, fatigue, trouble sleeping, bloating, cramping, headaches, and muscle aches, Tolentino says.
To help your doctor figure out what could be causing PMS symptoms, Tolentino suggests asking yourself questions like, how often you’re getting symptoms—was it just once or do you feel horrible every month? Also, what exactly makes you feel horrible, is it fatigue, or pain, or sleep issues? “Paying attention to how often these things happen is really important info for the doctor. Paying close attention to your period and the symptoms you have leading up to it can help you to better understand your body, and also potentially identify any emerging health issues,” Tolentino says. She recommends keeping a period diary so you can arm yourself with the right info when you meet with a doctor, including what you’re experiencing and when. “That can help you to get more familiar with your cycle and track your experience of any major or minor symptoms,” she adds.
While there’s no single test that can diagnose PMS or PMDD, this information will serve as a starting point for your doctor to investigate what’s going on. Even hormonal testing isn’t foolproof, Dr. Tolentino warns.
How a PMS treatment is identified
“Many women have normal circulating sex hormone levels—and even normal serotonin levels—and still experience PMS symptoms, so estrogen and progesterone testing may not always be useful in diagnosing or treating PMS,” she says.
However, other types of diagnostic tests may be useful to rule out the possibility that your PMS symptoms aren’t also related to an underlying disorder, such as a thyroid condition.
“If a patient is experiencing debilitating PMS symptoms, I’ll typically run a full hormone panel (including cortisol, thyroid, and sex hormone levels) as well as a nutrient panel and more to help me get closer to figuring out the best treatment for her,” explains Dr. Tolentino.
While some doctors might suggest hormonal birth control to help with PMS symptoms, there can be pros and cons, so you should take time to think about what works for your unique situation. Talk to a doctor who knows your health and health history, Tolentino notes.
Besides medications, there are some other options you can try to control PMS symptoms. While it depends on what exactly you’re experiencing, simple lifestyle adjustments might help.
6 lifestyle changes to help you get PMS relief
Maintaining a generally healthy lifestyle with frequent exercise, good sleep hygiene, and reducing stress are all important factors, Tolentino says. Here’s exactly how to make that happen—and why it’s key to treating your PMS.
1. Focus on exercise three to five times a week.
Tolentino suggests aerobic exercise several times a week to boost your endorphins and your mood, as well as better blood flow. One small 2018 study in BMC Women’s Health found that those who exercised three times a week for 20 minutes each, for eight weeks, experienced a drop in physical PMS symptoms like bloating, constipation, headaches, and nausea. The researchers say that exercise can help with the movement of prostaglandin to reduce discomfort, and can increase endorphins and pain tolerance. A walk or yoga are also good choices. “The important thing to remember is that you may want to modify your fitness regimen depending on how you’re feeling, but in general exercise can be very beneficial,” Tolentino says.
2. Get seven to eight hours of uninterrupted sleep at night.
Sleep is one of the most powerful tools in helping to combat fatigue, anxiety, and depressive symptoms, Tolentino says. A good night’s rest can determine how you feel the next day in terms of mood and energy. Unfortunately, PMS and PMDD have also been linked to poor sleep quality. Researchers have found that those with PMDD have a lower response to melatonin, the hormone involved in the sleep-wake cycle. So it’s important to implement good sleep hygiene to better regulate your sleep-wake cycle, like setting a bedtime and wake up time.
3. If you’re a smoker, get help to quit.
Smokers may have more severe PMS symptoms, so that’s another reason it’s probably smart to quit ASAP. One study found a link between smoking and PMS, as well as PMDD. “Most likely the causes behind cigarette smoking and increased risk of developing PMS or PMDD are multifactorial and related to the impact smoking has on the regulation of our menstrual cycle, its negative impact on the circulatory system, and its potential link to reduced vitamin D levels among several other potential causes,” Tolentino explains.
4. Eating a balanced, nutrient-rich diet.
Aim to eat a balanced diet, filled with lots of vegetables and fruit, especially leafy greens, which pack iron and B vitamins, Tolentino says. Researchers have linked a high intake of B vitamins, particularly riboflavin and thiamine (found in fortified milk and cereal, leafy greens, lentils, bananas, beans, seafood, and red meat), to a lower incidence of PMS. Reducing salt can also help alleviate some bloating, while limiting processed foods, refined sugar, alcohol, and caffeine can also support better sleep if you’re finding that sleep issues are a PMS symptom for you, Tolentino says.
Reducing sugar and alcohol and increasing foods like fish, avocado, and nuts (all filled with healthy fats), cruciferous veggies, and high-fiber foods may also help with estrogen metabolism and hormonal balance, which can also ultimately help with PMS symptoms.
5. Try a tailored supplement regimen.
Depending on what your exact symptoms are and what your doctor thinks may be causing them, supplements could help with your symptoms. Tolentino says she sees success with some vitamin supplementation not just for PMS treatment but in life in general. Though vitamins needs are very individualized, Tolentino gives the example that vitamin D might not only help someone who is fatigued before their period, but on other days too. Calcium may also help with mood-related symptoms, while vitamin B6, magnesium, and curcumin might help with both psychological side effects of PMS (like depressive symptoms) and physical ones (like discomfort). You might also find supplements, like SPM Active, that focus on targeting those inflammatory prostaglandins to alleviate signs of PMS.
“The key to trying supplements is to work with your healthcare provider to set a safe, effective dose,” Tolentino says. “Supplements like magnesium may offer cumulative, rather than instantaneous benefits, so you’re going to want to begin a supplement regimen as soon as possible to begin seeing benefits.”
6. Make note of your stress.
Stress can play a factor in PMS symptoms for a number of reasons, as well, including elevating the hormone cortisol, and messing with other hormones in the body. “All hormones are connected in the body, so if one of them is off consistently or constantly, that can affect things like the thyroid and adrenal glands,” Tolentino says, both responsible for metabolism and both of which, when they’re not running properly, can cause tiredness.
Becoming aware of your stress and learning how to cope with it are super important. While exercise, meditation, breathwork, guided imagery, and other relaxation techniques can all help lower stress levels, Tolentino says, knowing your personal stress level, how stress affects you and what situations trigger stress are powerful ways to start addressing tension. She recommends journaling to get to know how you deal with stress.
“Your menstrual cycle is the fifth vital sign—it’s another tool and process we can use to understand our health and wellbeing,” Tolentino says. “Periods can be uncomfortable sometimes, but they should not be absolutely debilitating…. Don’t ignore serious symptoms! Your body is often trying to tell you something and it’s up to you to listen and respond to it.”